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Primary lesions
Secondary lesions
Configurations
Area alternations
Locations
Final stages
Functional changes
SKIN
Epidermis – the thickness from 0,05mm
(eyelid) to 1,5mm (palms, soles)
Dermis (corium) – 0,3 to 3,0mm
Subcutis
Epidermis
Dermis
Pars papilaris
Pars reticularis
Fibres: elastic, collagen, reticular
Cells: fibroblasts fibrocytes macrophages, mast cells,
lymphocytes, histiocytes,..
Vessels: blood and lymphatic
Nervous fibres, corpuscles and endings
Skin appendages: hair follicles, sebaceous glands,
sweet apocrinne and eccrinne glands, nails,muscules
Examination of patients with skin conditions
Site
Type of lesion a) primary b) secondary
Form a) size b) shape c) margination
d) surrounding area
Color
Surface
Consistency (hard, soft,..)
Subjective symptome (burning, itchy,..)
PRIMARY LESIONS
Macule
Papule
Nodule, tuber
Urtica, wheal
Vesicle, bulla
Pustule
MACULE (spot)
A circumscribed area of change in normal skin
color without elevation or depression of the
surrounding skin. It is not palpable.
Macules may be the result of :
hyperpigmentation or hemosiderin (e.g. brown as
in lentigos,ephelides,...)
depigmentation (e.g. vitiligo)
MACULE (spot) – cont.
permanent vascular dilation (telangiectasie,
capillary haemangioma or transient capillary
dilation (erythema)
Purpura, petechiae - the extravasation of the red
cells
Diascopy – pressure of a glass slide on
the red lesion.
If redness remains- the lesion may be
purpuric
If the redness disappears - the lesion is
erythematous and is due to vascular
dilatation.
PAPULE (pimple)
Intraepidermal vesicle
Subepidermal vesicle
PUSTULE
superficial, elevated lesion that contains pus
(pus in a blister).
Pustules may vary in size and shape.
The color may appear white, yellow, or
greenish-yellow depending on the color of the
pus.
Pus is composed of leukocytes with or
without cellular debris.
It may also contain bacteria (non sterile) or
may be sterile (leukocytes only).
Secondary Lesions
Squama
Crusta
Fissura, rhagas
Eschara
Erosio
Ulcus
SQUAMA (scale)
accumulation or abnormal shedding of
horny layer keratin (stratum corneum)
Scales usually indicate inflammatory change and
thickening of the epidermis.
The may be fine, as in pityriasis;
white and silvery, as in psoriasis;
or large and fish-like, as in ichtyosis.
- tatoo,
- gold salts (chrysiasis),
- silver salts (argyrosis)
INCRUSTATION
Deposition in the
skin of the proper
particles.
- deposits of calcium in
the skin - calcinosis
FUNCTIONAL CHANGES
Keratosis
Steatosis
Hidrosis
Chromiae
Trichosis
Onychosis
Functional changes:
Quantitative:
- afunction- loss of the function
- hypofunction
- hyperfunction
Qualitative:
- dysfunction – change of the function
Keratosis- the function changes of
keratinization: